ABSTRACT
Histórico: a terapia de ressincronização cardíaca (TRC) melhora a qualidade de vida, a classe funcional de NYHA, a capacidade para o exercício e diminui as internações de pacientes portadores de insuficiência cardíaca severa e QRS alargado. Em indivícuos com outras formas de insuficiência cardíaca, os benefícios da TRC permanecem incertos. Objetivo: Identificar subgrupos de pacientes portadores de insuficiência cardíaca e que podem ser beneficiados pela estimulação biventricular. Casuística e Método: Foram avaliados 144 pacientes com insuficiência cardíaca submetidos à TRC após três meses de seguimento. Dados demográficos, ecocardiográficos, eletrocardiográficos e clínicos foram verificados para avaliar os resutlados da classe funcional e da duração de QRS pré e pós-implante. Resultados: Identificou-se 20, 88 e 36 pacientes nas classes funcionais II, III e IV da NYHA, respectivamente...
Subject(s)
Humans , Heart Failure/etiology , Echocardiography , Pacemaker, Artificial , Retrospective StudiesABSTRACT
OBJECTIVE: To identify subgroups of heart failure patients who might benefit from biventricular pacing. BACKGROUND: Cardiac resynchronization therapy (CRT) improves the quality of life, New York Heart Association (NYHA) functional class, and exercise capacity and decreases hospitalizations for heart failure for patients who have severe heart failure and a wide QRS. It is unclear if other populations of heart failure patients would benefit from CRT. METHODS: One hundred forty-four consecutive heart failure patients who underwent CRT and completed 3 months of follow-up were reviewed. Demographic, echocardiographic, electrocardiographic, and clinical outcome data were analyzed to assess the relationship of functional class and QRS duration before device implantation to postimplant outcomes. RESULTS: There were 20, 88, and 36 patients in NYHA functional class II, III, and IV, respectively. Thirty-four patients had right ventricular pacing and another 29 patients had a QRS duration < or = 150 ms. Patients who were in NYHA functional class II at baseline had significant improvement in left ventricular ejection fraction and indices of left ventricular remodeling after CRT. Similar significant findings were seen in the subgroup with right ventricular pacing at baseline after CRT. However, in the subgroup with a narrow QRS duration, there were no significant changes in the indices of left ventricular remodeling or in the NYHA functional class and there was a significant increase in the QRS duration. For the study cohort as a whole, an improvement in NYHA functional class after CRT correlated with a significant decrease in adverse clinical outcomes. CONCLUSIONS: Heart failure patients who were in NYHA functional class II and those with right ventricular pacing appeared to benefit from CRT.
Subject(s)
Cardiac Pacing, Artificial/methods , Cardiac Pacing, Artificial/statistics & numerical data , Heart Failure/epidemiology , Heart Failure/prevention & control , Heart Ventricles , Ventricular Dysfunction, Left/epidemiology , Ventricular Dysfunction, Left/prevention & control , Aged , Comorbidity , Female , Humans , Male , Middle Aged , Ohio/epidemiology , Prevalence , Retrospective Studies , Risk Assessment/methods , Risk Factors , Treatment OutcomeSubject(s)
Fissure in Ano/virology , HIV Infections/diagnosis , Skin Diseases/virology , AIDS-Related Opportunistic Infections , Diagnosis, Differential , Fissure in Ano/microbiology , HIV Infections/complications , Humans , Inflammatory Bowel Diseases/diagnosis , Male , Middle Aged , Rectal Diseases/microbiology , Rectal Diseases/virologySubject(s)
Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage , Perioperative Care , Surgical Procedures, Operative , Cardiovascular Diseases/prevention & control , Humans , Intraoperative Complications/prevention & control , Postoperative Complications/prevention & control , RiskABSTRACT
This study evaluated the utility of atrioventricular (AV) optimization using Doppler echocardiography in patients who undergo cardiac resynchronization therapy (CRT). AV optimization in patients who undergo CRT is performed inconsistently, with few data supporting its utility. Data were collected from 215 patients in New York Heart Association class III or IV heart failure (66% ischemic) who underwent AV optimization <30 days after implantation from 1999 to 2003. All patients arrived with AV delay programmed at the time of their CRT procedures (100 to 120 ms). AV delay was optimized using Doppler mitral inflow data to target stage I diastolic filling. Baseline clinical characteristics, AV delay, and diastolic functional stage were recorded. The mean follow-up period was 23 months. Five hundred patients underwent CRT, 215 of whom underwent AV optimization <30 days after implantation. Baseline mean age was 66 +/- 12 years, left ventricular (LV) ejection fraction 19 +/- 8%, LV end-diastolic dimension 6.5 +/- 1 cm, LV end-systolic dimension 5.5 +/- 1 cm, QRS duration 166 +/- 27 ms, and time to AV optimization 2.5 +/- 4 days. Baseline and final AV delay means were 120 +/- 25 and 135 +/- 40 ms, respectively (p = 0.0001). In 40% of patients (86 of 215), final AV delay settings were >140 ms. Left atrial diameter and AV block predicted patients in whom AV delay settings >140 ms were optimal. There was no difference in mortality in patients with final AV delays of >140 ms. In conclusion, AV optimization in patients who underwent CRT resulted in final AV delay settings of >140 ms in 40% of patients. AV delay optimization based on Doppler echocardiographic determination of optimal diastolic filling is useful and safe in patients who undergo CRT.
